Colorectal cancers are the third most common invasive cancers among men and women in the United States. Improvements in prevention, screening and treatment have resulted in decreasing case-fatality rates from colorectal cancer since the 1980s. Paradoxically, disparities in survival from this cancer especially between Blacks and Whites have widened over time. Although there is no consensus in existing literature, current evidence suggests that factors related to access to health care including socioeconomic differences contribute to these disparities. The goal of the proposed research program is to identify potentially modifiable causes of disparities in cancer survival with a long range goal of reducing or eliminating the disproportionate burden of colorectal cancer among certain patient populations. The specific aims for this project are to: 1) compare colorectal cancer survival rates by race/ethnicity over the period 1993 through 2004; 2) compare the distribution of tumor stage at diagnosis for colorectal cancer by race/ethnicity; 3) examine potential mediators of the relationship of survival and race/ethnicity among colorectal cancer patients; 4) examine the patterns of care of survivors of colorectal cancer; and 5) explore the effect of socioeconomic status on the relationship between race/ethnicity and survival among colorectal cancer patients. This project will be conducted on a large racially diverse cohort comprised of patients 20 years and older diagnosed with colorectal cancer (1993 to 2004) while enrolled in one of four integrated health care systems that are affiliated with the National Cancer Institute-funded Cancer Research Network. This research plan is part of a career development program aimed at providing the training and experience needed for Dr. Doubeni to become an independently funded clinician-investigator focusing on disparities in cancer survival. The objectives of the career development plan are to acquire knowledge and skills in: 1) cancer biology, epidemiology and treatment; 2) advanced research methods; 3) scientific writing; and 4) the translation of research into practice and policy. The career development program will be accomplished through mentoring and targeted advanced courses. The studies encompassed under the proposed research program will make important contributions to our understanding of racial/ethnic differences in cancer survival rates. The proposed project will lay the foundation for the candidate's long-term career goal of designing system-based interventions aimed at eliminating disparities in cancer care and survival, a major objective of HealthyPeople 2010. [unreadable] [unreadable] [unreadable]